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1. What is the first type of cell produced by the developing em-

bryo?
A. Erythrocyte
A. Erythrocyte
B. Granulocyte
C. Lymphocyte
D. Thrombocyte
2. What percentage of tissue located in the bone marrow cavities
of adults is fat?
A. 10%
C. 50%
B. 25%
C. 50%
D. 75%
3. Which of the following is a characteristic of pluripotent
hematopoietic stem cells?
A. Does possess self-renewal ability
B. Produce progenitor cells that are not restricted to any specific B. Does possess self-renewal ability
cell lineage
C. Express the stem cell marker CD23
D. Are morphologically recognizable
4. In an adult, what are the two best areas for obtaining active
bone marrow by aspira-tion? A. Vertebra, tibia
B. Sternum, vertebra D. Posterior iliac crest, sternum
C. Anterior iliac crest, tibia
D. Posterior iliac crest, sternum
5. What is the normal ratio of myeloid to erythroid precursors in
bone marrow (M:E ratio)?
A. 1:1
C. 4:1
B. 1:3
C. 4:1
D. 8:1
6. Which of the following accurately describe hematopoietic
growth factors?
A. Bind to target cell receptors to express activity
A. Bind to target cell receptors to express activity
B. Action of majority is lineage restricted
C. Does not promote or suppress cell death
D. Does not stimulate or inhibit cell prolif-eration
7. In the third month of gestation, what is the primary site of
hematopoiesis?
A. Liver
B. Marrow of long bones A. Liver
C. Spleen
D. Yolk sac
8. The mechanism that relays information about tissue oxygen
levels to erythropoietin-producing sites is located in the
A. Brain
B. Kidney
B. Kidney
C. Liver
D. Spleen
9. Antigen-independent lymphopoiesis occurs in primary lym-
phoid tissue located in the
A. Liver and kidney
B. Spleen and lymph nodes D. Thymus and bone marrow
C. Peyer's patches and spleen
D. Thymus and bone marrow
10. Programmed cell death is called
A. Necrosis
B. Apoptosis C. Apoptosis
C. Cellular senescence
D. Terminal differentiation
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11. In what area of the bone marrow does hematopoiesis take

place?
A. Cords
A. Cords
B. Endosteum
C. Endothelium
D. Sinuses
12. Bone marrow cellularity refers to the ratio of
A. Red cell precursors to white cell precur-sors
B. Hematopoietic tissue to adipose tissue B. Hematopoietic tissue to adipose tissue
C. Granulocytic cells to erythrocytic cells
D. Extravascular tissue to intravascular tissue
13. New research has shown that interleukins and colony stimu-
lating factors can be pro-duced by many different cells including:
A. B lymphocytes and erythrocytes
C. Monocytes and T lymphocytes
B. Erythrocytes and thrombocytes
C. Monocytes and T lymphocytes
D. Neutrophils and monocyte
14. What is the approximate total blood vol-ume in an adult?
A. 1 L
B. 2 L C. 6 L
C. 6 L
D. 12 L
15. The myeloid progenitor cell can produce cells committed to
A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lin-
eages
B. Granulocytic, monocytic, lymphocytic, or megakaryocytic lin- A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lin-
eages eages
C. Erythrocytic, granulocytic, monocytic, or lymphocytic lineages
D. Erythrocytic, granulocytic, lymphocytic, or megakaryocytic lin-
eage
16. The largest hematopoietic cells in normal bone marrow are
A. Osteoblasts
B. Osteoclasts C. Megakaryocytes
C. Megakaryocytes
D. Plasma cells
17. When evaluating a bone marrow aspirate smear, which finding
is considered abnor-mal?
A. A predominance of granulocyte precur-sors as compared to
nucleated red cells
B. Detection of stainable iron in macro-phages and erythroid D. The presence of 10% myeloblasts on the cell differential count
precursors with Prussian blue
C. An average of three megakaryocytes seen per low power (10*)
field
D. The presence of 10% myeloblasts on the cell differential count
18. As most blood cell lines mature, which of the following is
characteristic?
A. Cell diameter increases B. Nucleus to cytoplasm ratio (N:C) decreases C. Nuclear chro-
B. Nucleus to cytoplasm ratio (N:C) decreases matin becomes less condensed
C. Nuclear chromatin becomes less condensed
D. Basophilia of the cytoplasm increases
19. Which of the following describes thrombo-poietin (TPO)?
A. Renal hormone that regulates marrow red cell production
B. Marrow hormone secreted by develop-ing megakaryoblasts
C. Hormone produced by the liver that stimulates megakary-
C. Hormone produced by the liver that stimulates megakary-
opoiesis
opoiesis
D. Pituitary hormone that controls platelet sequestration by the
spleen
20. When the hepatic phase of fetal life is reactivated in an adult,
hematopoiesis can be termed
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A. Myeloid or medullary
B. Myeloid metaplasia or extramedullary
B. Myeloid metaplasia or extramedullary
C. Myelophthisis or myelodysplasia
D. Mesoblastic or mesenchymal
21. What is the average life span of a normal red blood cell?
A. 1 day
B. 10 days D. 120 days
C. 60 days
D. 120 days
22. The Na+ -K+ cation pump is an important mechanism in
keeping the red blood cell intact. Its function is to maintain a high
level of
A. Intracellular Na+ B. Intracellular K+
B. Intracellular K+
C. Plasma Na+
D. Plasma K+
23. Which of the following depicts the struc-ture of the hemoglobin
molecule?
A. Two heme groups, two globin chains
D. Four heme groups, four globin chains
B. Four heme groups, two globin chains
C. Two heme groups, four globin chains
D. Four heme groups, four globin chains
24. Which of the following describes the pro-cess known as
culling?
A. Release of red cells from the bone marrow
D. Removal of abnormal red cells by the spleen
B. Binding of free hemoglobin by transport proteins
C. Incorporation of iron into protoporphyrin IX
D. Removal of abnormal red cells by the spleen
25. Hemoglobin forms that are incapable of oxygen transport
include
A. Deoxyhemoglobin and oxyhemoglobin
C. Carboxyhemoglobin and methemoglobin
B. Oxyhemoglobin and carboxyhemoglobin
C. Carboxyhemoglobin and methemoglobin
D. Methemoglobin and deoxyhemoglobin
26. The majority of iron found in an adult is a constituent of
A. Ferritin
B. Myoglobin C. Hemoglobin
C. Hemoglobin
D. Peroxidase
27. A common source of interference in the cyanmethemoglobin
method is
A. Hemolysis
B. Very high WBC count
B. Very high WBC count
C. Cold agglutinin
D. Clumped platelets
28. What red cell morphologic abnormality is described by the
term "poikilocytosis"?
A. Variations in size
B. Deviations from normal shape
B. Deviations from normal shape
C. Presence of inclusions
D. Alterations in hemoglobin concentration
29. Howell-Jolly bodies are composed of
A. DNA
B. Iron A. DNA
C. Reticulum
D. RNA
30. When spherocytes are reported, what is observed on the
peripheral blood smear?
A. Red cells without a central pallor
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B. Red cells with blunt projections

C. Red cells with sharp projections A. Red cells without a central pallor
D. Red cells with intracellular rod-shaped crystals
31. The red cells found in lead poisoning characteristically ex-
hibit coarse granules composed of that are reported as
.
A. precipitated hemoglobin; Pappenheimer bodies B. aggregated ribosomes; basophilic stippling
B. aggregated ribosomes; basophilic stippling
C. nuclear fragments; Pappenheimer bodies
D. excess iron deposits; basophilic stippling
32. The most characteristic peripheral blood smear finding in
multiple myeloma is:
A. Plasmacytic satellitosis in the bone mar-row
D. Rouleaux formation of the red cells
B. Many plasma cells in the peripheral blood
C. Many mott cells in the peripheral blood
D. Rouleaux formation of the red cells
33. Which of the following is most frequently associated with the
inclusion bodies seen in Color Plate 1 ?
A. Iron-overload state
C. Post-splenectomy
B. Post-transfusion
C. Post-splenectomy
D. Iron-deficient state
34. Which of the following statements about iron absorption is
true?
A. Absorption occurs in the ileum.
B. The mucosal cell always absorbs the correct amount of iron to C. Absorption increases when erythropoi-etic activity increases.
meet needs.
C. Absorption increases when erythropoi-etic activity increases.
D. Alkaline pH favors absorption.
35. What term describes a mature red blood cell that contains iron
granules or deposits?
A. Siderosome
D. Siderocyte
B. Sideroblast
C. Ringed sideroblast
D. Siderocyte
36. Which of the following is associated with a "shift to the left" in
the oxygen dissociation curve of hemoglobin?
A. Decreased pH and elevated temperature
C. Decreased oxygen release
B. Decreased oxygen affinity
C. Decreased oxygen release
D. Presence of 2,3-bisphosphoglycerate (2,3-BPG)
37. Which of the following statements does not characterize ery-
thropoietin (EPO)?
A. Transforms the CFU-E into the earliest recognizable RBC pre-
cursor
B. Increases the rate of red blood cell pro-duction by the bone D. Decreases stimulation of erythropoiesis when cellular hypoxia
marrow increase
C. Shortens the maturation time of devel-oping erythroid precur-
sors
D. Decreases stimulation of erythropoiesis when cellular hypoxia
increase
38. Which of the following factors will result in an immediate
increase in oxygen delivery to the tissues?
A. Increased pH
B. High altitudes C. Increased hemoglobin binding of 2,3-BPG
C. Increased hemoglobin binding of 2,3-BPG
D. Increased renal release of erythropoietin
39. Periods of intense erythropoietin activ-ity cause premature re-
lease of marrow reticulocytes into the blood. Which of the following
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is not true of these early reticulo-cytes?

A. Loss of residual RNA occurs immedi-ately upon marrow re-
lease
A. Loss of residual RNA occurs immedi-ately upon marrow release
B. Circulate longer than usual before reaching maturity
C. May be termed "shift or stress reticulo-cytes"
D. Show diffuse basophilia with Wright's stain
40. Which of the following inclusions is only visible with supravital
staining?
A. Basophilic stippling
C. Heinz bodies
B. Cabot rings
C. Heinz bodies
D. Pappenheimer bodies
41. The presence of schistocytes on the pe-ripheral blood smear
is commonly associ-ated with
A. Increased iron mobilization
B. Increased red cell destruction
B. Increased red cell destruction
C. Decreased erythropoietin activity
D. Decreased red cell proliferation
42. Which of the following may be a sign of accelerated bone
marrow erythropoiesis?
A. Hypercellular marrow with a decreased number of RBC precur-
sors C. Nucleated red cells in the peripheral circulation
B. Bone marrow M:E ratio of 6:1
C. Nucleated red cells in the peripheral circulation
D. Low erythrocyte, hemoglobin, and he-matocrit level
43. Microcytic, hypochromic red cells are most often associated
with impaired
A. DNA synthesis
C. Hemoglobin synthesis
B. RNA metabolism
C. Hemoglobin synthesis
D. Enzyme metabolism
44. When in bone marrow, the nucleated red cells present in Color
Plate 2 would be staged as
A. Basophilic normoblasts
C. Orthochromic normoblasts
B. Polychromatophilic normoblasts
C. Orthochromic normoblasts
D. Pronormoblasts
45. When acanthocytes are found on the blood smear, it is usually
the result of
A. Abnormal membrane permeability
B. Altered membrane lipids B. Altered membrane lipids
C. Mechanical trauma
D. Polymerization of hemoglobin molecules
46. Which erythrocyte metabolic pathway generates adenosine
triphosphate (ATP) via glycolysis?
A. Embden-Meyerhof
A. Embden-Meyerhof
B. Hexose monophosphate
C. Rapoport-Luebering
D. Methemoglobin reductase
47. Which of the following red blood cell pre-cursors is the last
stage to undergo mitosis?
A. Pronormoblast
B. Basophilic normoblast C. Polychromatophilic normoblast
C. Polychromatophilic normoblast
D. Orthochromic normoblast
48. The major adult hemoglobin requires the synthesis of al-
pha-globin chains and
A. Beta-globin chains A. Beta-globin chains
B. Delta-globin chains
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C. Epsilon-globin chains
D. Gamma-globin chains
49. Defective nuclear maturation commonly re-sults in the produc-
tion of red cells that are
A. Normocytic
C. Macrocytic
B. Hypochromic
C. Macrocytic
D. Microcytic
50. The major storage form of iron is
A. Ferritin
B. Transferrin A. Ferritin
C. Hemosiderin
D. Hemachromatin
51. The red cells observed on a peripheral blood smear show
extreme anisocytosis with an equal number of macrocytes and
microcytes. Which of the following values correlate with this find-
ing?
B. MCV 90.0 fL, RDW 25.0%
A. MCV 108.0 fL, RDW 14.0%
B. MCV 90.0 fL, RDW 25.0%
C. MCV 75.0 fL, RDW 16.0%
D. MCV 88.0 fL, RDW 12.0%
52. Excessive extravascular red cell destruction is associated with
A. Hemoglobinemia
B. Bilirubinemia B. Bilirubinemia
C. Hemoglobinuria
D. Hemosiderinuria
53. Which protein is primarily responsible for transport of hemo-
globin dimers resulting from intravascular hemolysis?
A. Hemopexin
D. Haptoglobin
B. Albumin
C. Hemosiderin
D. Haptoglobin
54. The morphologic abnormality characteristi-cally found in he-
moglobinopathies is
A. Elliptocytes
C. Codocytes
B. Dacryocytes
C. Codocytes
D. Discocytes
55. Where do the early and late stages of heme synthesis occur?
A. On ribosomes
B. In mitochondria B. In mitochondria
C. In cytoplasm
D. In nucleoli
56. Spectrin is a protein that occupies a major role in
A. Red cell membrane structure
B. Reducing ferric iron A. Red cell membrane structure
C. Red cell transport and removal of CO2
D. Iron recovery during hemoglobin deg-radatio
57. What is the function of reduced glutathi-one (GSH) in the red
blood cell?
A. Promotes Kreb's cycle activity
C. Neutralizes intracellular oxidants that accumulate
B. Maintains anion balance during the "chloride shift"
C. Neutralizes intracellular oxidants that accumulate
D. Prevents oxygen uptake by hemoglobin

58. What does measuring the total iron-binding capacity (TIBC)

represent?
A. Amount of free iron in serum C. Amount of iron that transferrin
B. Circulating protein-bound iron

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C. Amount of iron that transferrin can bind

D. Indirect measurement of iron stores
59. Serum ferritin is a good indicator of the amount of
A. Cytochrome iron
B. Storage iron B. Storage iron
C. Hemoglobin iron
D. Transferrin saturation
60. Fetal hemoglobin differs from adult hemoglobin in that hemo-
globin F
A. Has a lower oxygen affinity
B. Resists elution from red cells with acid solutions
B. Resists elution from red cells with acid solutions
C. Is no longer synthesized after birth in a normal individual
D. Has four gamma-globin chain
61. Impaired DNA metabolism is characteristic of
A. Hemoglobin C disease
B. Iron-deficiency anemia D. Megaloblastic anemia
C. Sideroblastic anemia
D. Megaloblastic anemia
62. Which of the following is associated with glucose-6-phosphate
dehydrogenase (G6PD) deficiency?
A. G6PD gene is located on the X chro-mosome.
B. Ongoing intravascular hemolysis occurs. A. G6PD gene is located on the X chro-mosome.
C. All circulating red cells, including reticulocytes, lack enzyme
activity.
D. Splenectomy can relieve the rate of red cell destruction.
63. In regard to variant hemoglobin E, ±2 ²s2tatements is false?
A. There are two normal alpha chains.
B. Glutamic acid replaces lysine on posi-tion 26 of the beta chains.
C. Hemoglobin E is the second most common hemoglobin variant B. Glutamic acid replaces lysine on posi-tion 26 of the beta chains.
known.
D. Glutamic acid is normally found at position 26 of the beta chain.
26 Glu S Lys, which of the following
64. Color Plate 3 shows the peripheral blood of a 16-year-old
female with a sporadic history of dizzy spells, fainting, and jaun-
dice. This patient also had a his-tory of periodic abdominal pain
related to gallstones. Upon physical examina-tion, she exhibited
mild splenomegaly. Her hemoglobin was 107 g/L (10.7 g/ dL),
hematocrit was 0.32 L/L (32%), red cell indices were normal, and
the direct antiglobulin test was negative. Based on history and C. An intrinsic hereditary defect of red cells should be suspected.
peripheral blood morphol-ogy, which of the following statements
is most likely true?
A. Hemoglobin S will be revealed by elec-trophoresis.
B. Tests to confirm iron deficiency should be ordered.
C. An intrinsic hereditary defect of red cells should be suspected.
D. The anemia is secondary to spleen and gallbladder disorders
65. A 9-month-old male was seen in the Emergency Depart-
ment with a femur fracture that had occurred from a fall down
the stairs. Upon physical examination, the physician noted he-
patosplenomegaly, extreme pallor, and a slight arrhythmia. A
complete blood count revealed the following:
The Wright stained blood smear showed the findings seen in Color
Plate 4 . Hemoglobin electrophoresis was ordered with results as
B. Cooley beta-thalassemia major
follows: 97% Hgb F and 3% Hgb A2
Which condition is most likely causing the hematologic abnormal-
ities?
A. Alpha-thalassemia major
B. Cooley beta-thalassemia major
C. Hemoglobin H disease
D. Hereditary persistence of hemoglobin F

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66. A 14-year-old African-American male was seen in the clinic for
abdominal pain. A com-plete blood count revealed the following:
The perapheral smear showed the red blood cell morphology seen
in Color Plate 5 . What condition is suggested by these findings?
C. Hemoglobin SC disease
A. Hemoglobin E disease
B. Hemoglobin S disease
C. Hemoglobin SC disease
D. Hemoglobin C disease
67. Pica is most commonly associated with which of the following
conditions?
A. Pyridoxine deficiency
C. Iron deficiency
B. Lack of erythrocyte folate
C. Iron deficiency
D. Porphyrias
68. Of the following, the leading cause of folate deficiency is
A. Increased requirements
B. Dietary insufficiency B. Dietary insufficiency
C. Drug inhibition
D. Malabsorption
69. Which of the following statements about sickle cell syndrome
is false?
A. Asplenism may result from repeated sickling crises in the
homozygous state.
B. Heterozygous persons may be partly protected from infection C. Hemoglobin S is more soluble in dithi-onite than is normal
by falciparum malaria. hemoglobin.
C. Hemoglobin S is more soluble in dithi-onite than is normal
hemoglobin.
D. Trait conditions are generally asymp-tomatic with no sickle cell
formation.
70. The findings seen in Color Plate 6 can be found in patients
with microangiopathic hemolytic anemia (MAHA). Which of the
following conditions could not be respon-sible for this type of red
cell destruction?
A. Disseminated intravascular coagulation (DIC) D. Idiopathic thrombocytopenic purpura (ITP)
B. Hemolytic uremic syndrome (HUS)
C. Thrombotic thrombocytopenic purpura (TTP)
D. Idiopathic thrombocytopenic purpura (ITP)
71. Which one of the following blood find-ings correlates with the
presence of ringed sideroblasts in the bone marrow?
A. Pappenheimer bodies
B. Basophilic stippling A. Pappenheimer bodies
C. Increased MCHC
D. Increased spherocytes
72. Which one of the following conditions is usually associated
with marked reticulocy-tosis?
A. hereditary elliptocytosis
B. Drug-induced autoimmune hemolytic anemia B. Drug-induced autoimmune hemolytic anemia
C. Vitamin B12 deficiency
D. Pernicious anemia
73. Hereditary stomatocytosis manifests physi-ologically by
changes in
A. Hemoglobin oxygen affinity
B. Membrane cation permeability B. Membrane cation permeability
C. Efficiency of hemoglobin reduction
D. Glycolytic ATP production

74. In addition to an increase in red blood cells, which of the

following is characteristic of polycythemia vera?
A. Decreased platelets, decreased granulo-cytes, decreased ery-
thropoietin level

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B. Decreased platelets, decreased granulo-cytes, increased ery-
thropoietin level
C. Increased platelets, increased granulo-cytes, increased ery- D. Increased platelets, increased granulo-cytes, decreased ery-
thropoietin level thropoietin level
D. Increased platelets, increased granulo-cytes, decreased ery-
thropoietin level
75. Which of the following is not characteristic of aplastic anemia?
A. Extramedullary hematopoiesis
B. Bone marrow hypoplasia A. Extramedullary hematopoiesis
C. Absolute reticulocytopenia
D. Blood findings of pancytopenia
76. What values would you expect to obtain on hemoglobin and
hematocrit determinations done immediately after a major he-
mor-rhage, if hemoglobin and hematocrit values were normal prior
to the hemorrhage?
A. Both normal
A. Both normal
B. Both decreased
C. Hemoglobin decreased, hematocrit normal D. Hemoglobin nor-
mal, hematocrit de-crease
77. Results from a 1-day-old infant include a hemoglobin of 201
g/L (20.1 g/dL), hema-tocrit of 0.60 L/L (60.0%), MCV of 110.2 fL,
and four nucleated red cells/100 WBCs. How should these results
be interpreted?
A. The elevated hemoglobin and hemato-crit values indicate pos-
sible dehydration. D. No further testing is indicated.
B. The nucleated red cells suggest acceler-ated erythropoiesis
due to a hemolytic process.
C. Testing should be done to identify the cause of the macrocyto-
sis.
D. No further testing is indicated.
78. When viewing Color Plate 7 , the red blood cells with a single
elongated projec-tion are known as and may be seen in

A. acanthocytes; liver disease D. dacryocytes; myelofibrosis

B. echinocytes; liver disease
C. drepanocytes; myelofibrosis
D. dacryocytes; myelofibrosis
79. A patient with normocytic, normochromic anemia secondary
to small cell carcinoma may be exhibiting an anemia designated
as
A. Hemolytic C. Myelophthisic
B. Megaloblastic
C. Myelophthisic
D. Sideroblastic
80. Idiopathic aplastic anemia is best defined as a form of anemia
that
A. Has no identifiable cause
B. Is caused by a physician's treatment A. Has no identifiable cause
C. Follows exposure to ionizing radiation
D. Develops after a viral infection
81. Which of the following is a true red blood cell aplasia?
A. Marrow replacement anemia
B. Fanconi anemia C. Diamond-Blackfan anemia
C. Diamond-Blackfan anemia
D. Donath-Landsteiner anemia

82. Which one of the following is a cause of absolute secondary

erythrocytosis?
A. Defective cardiac or pulmonary function A. Defective cardiac or pulmonary function
B. Extreme heat

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 C. Dehydration secondary to diuretic use
D. Hemoglobins with decreased oxygen affinity
83. A cellulose acetate hemoglobin electropho-resis (alkaline pH),
performed on the blood of a stillborn infant, revealed a single
band that migrated farther toward the anode than did the Hb A
control. What is the most likely composition of the stillborn infant's
hemoglobin? B. Four gamma chains
A. Four beta chains
B. Four gamma chains
C. Two alpha and two beta chains
D. Two alpha and two gamma chains
84. The most likely cause of the stillborn in-fant's condition in
question 83 is
A. Erythroblastosis fetalis
C. Hydrops fetalis
B. Rh hemolytic disease of the fetus
C. Hydrops fetalis
D. ABO hemolytic disease of the newborn
85. Which of the following conditions show similar CBC and blood
smear findings?
A. Beta-thalassemia major and minor
B. Folic acid and vitamin B12 deficiencies
B. Folic acid and vitamin B12 deficiencies
C. Acute and chronic blood loss
D. Sickle cell disease and trait
86. Which of the following would be useful in identifying the cause
of the blood profile seen in Color Plate 8 ?
A. Osmotic fragility test
C. Direct antiglobulin test
B. Reticulocyte count
C. Direct antiglobulin test
D. Urine urobilinogen leve
87. Which of the following conditions is not as-sociated with the
presence of schistocytes and spherocytes?
A. Clostridial septicemia
D. Aplastic anemia
B. Prosthetic heart valves
C. Severe thermal burns
D. Aplastic anemia
88. A 30-year-old woman who has been vomiting for 3 days has a
hemoglobin value of 180 g/L (18.0 g/dL) and a hematocrit of 0.54
L/L (54.0%). Her results suggest the presence of
A. Absolute erythrocytosis D. Relative polycythemia
B. Primary polycythemia
C. Secondary polycythemia
D. Relative polycythemia
89. An excessive accumulation of iron in body tissues is called
A. Hemochromatosis
B. Erythroblastosis A. Hemochromatosis
C. Megaloblastosis
D. Acrocyanosis
90. Abetalipoproteinemia is characterized by mild anemia and
numerous on the peripheral blood smear.
A. acanthocytes
B. elliptocytes A. acanthocytes
C. echinocytes
D. stomatocytes
91. What is the most common cause of iron deficiency?
A. Bleeding
B. Gastrectomy A. Bleeding
C. Inadequate diet
D. Intestinal malabsorption

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 92. Which one of the following is acharacteris-tic of beta-tha-
lassemia major?
A. Transfusion-dependent anemia
A. Transfusion-dependent anemia
B. Decreased alpha chains result in excess beta chains.
C. Iron chelation therapy is not necessary.
D. Common in persons of Scandinavian ancestry
93. In the anemia of chronic disease, what are the usual serum
iron and transferrin levels?
A. Serum iron decreased, transferrin decreased
A. Serum iron decreased, transferrin decreased
B. Serum iron decreased, transferrin increased C. Serum iron
normal, transferrin normal
D. Serum iron increased, transferrin increased
94. In children, the most important effect of lead poisoning is on
the
A. Liver
C. Neurologic system
B. Kidney
C. Neurologic system
D. Development of erythrocytes
95. Which of the following would not result in the dual population
of red cells represented in Color Plate 9 ?
A. Blood transfusion
C. Spleen removal
B. Oral iron therapy
C. Spleen removal
D. Coexisting deficiencies
96. What is the most likely genetic defect in the hemoglobin of
cells seen in Color Plate 10 ?
A. Substitution of valine for glutamic acid in position 6 of the
alpha-globin chain
B. Substitution of valine for glutamic acid in position 6 of the B. Substitution of valine for glutamic acid in position 6 of the
beta-globin chain beta-globin chain
C. Substitution of lysine for glutamic acid in position 6 of the
alpha-globin chain
D. Substitution of lysine for glutamic acid in position 6 of the
beta-globin chain
97. On what criteria below is the classification of sickle cell trait
versus sickle cell disease based?
A. Severity of the clinical symptoms
B. Number of irreversibly sickled cells (ISCs) D. Percentage of hemoglobin S on electrophoresis
C. Level of compensatory hemoglobin F
D. Percentage of hemoglobin S on electrophoresis
98. Which of the following is the most appro-priate treatment for
sickle cell anemia?
A. Hydroxyurea
B. Supportive therapy B. Supportive therapy
C. Hyperbaric oxygen
D. Iron
99. Which of the following values can be used to indicate the
presence of a hemolytic anemia?
A. Hemoglobin level
B. Hematocrit level D. Reticulocyte count
C. Erythrocyte count
D. Reticulocyte count

100. A pre-operative, 20-year-old female has a mild microcytic

anemia, with target cells and stippled red cells observed on the
blood smear. Her hemoglobin A2 level is quantified at 5%. What
C. Heterozygous beta-thalassemia
do these findings suggest?
A. Iron-deficiency anemia
B. Heterozygous alpha-thalassemia

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 C. Heterozygous beta-thalassemia
D. Hemoglobin S/beta-thalassemia
101. What causes the hemolytic process in glucose-6-phosphate
dehydrogenase defi-ciency following oxidant exposure?
A. Coating of red cells by antibody
D. Precipitation of denatured hemoglobin
B. Osmotic pressure changes
C. Complement attachment
D. Precipitation of denatured hemoglobin
102. In clinically severe hereditary spherocytosis, which of the
following findings would not be found post-splenectomy?
A. Rise in the red cell count and hemoglo-bin level
B. Higher number of circulating reticulo-cytes
B. Higher number of circulating reticulo-cytes
C. Increased number of Howell-Jolly bod-ies
D. Transient elevation in the platelet count
103. Which of the following laboratory results is consistent with
accelerated red cell destruction?
A. Increased serum sodium
B. Increased plasma hemoglobin
B. Increased plasma hemoglobin
C. Increased serum chloride
D. Increased serum haptoglobin
104. Acquired hemolytic anemias are usually due to
A. Extracorpuscular factors
B. Defects within the bone marrow A. Extracorpuscular factors
C. Intracellular factors
D. Changes in hemoglobin stability
105. The antibody associated with paroxysmal cold hemoglobin-
uria shows specificity for
A. ABO antigens
C. P antigens
B. I antigens
C. P antigens
D. Rh antigens
106. A 69-year-old male is admitted with pallor, mild tachycardia,
and difficulty walking be-cause of numbness in the extremities. His
CBC reveals a hemoglobin of 78 g/L (7.8 g/dL), a hematocrit of
0.25 L/L (25.0%), and MCV of 118.5 fL. This patient's symp-toms
and the blood findings seen in Color Plate 11 are most suggestive
B. Vitamin B12
of anemia due to a lack of
A. Folic acid
B. Vitamin B12
C. Vitamin B6
D. Ascorbic acid
107. A clinical laboratory scientist examined a Wright stained pe-
ripheral smear and saw what appeared to be small, dark-staining
granules in the mature erythrocytes. A sec-ond smear was stained
with Prussian blue and a positive result was obtained. Based on
this information, which of the following would you expect to be
B. Serum ferritin level
abnormal?
A. Plasma hemoglobin level
B. Serum ferritin level
C. Hemoglobin electrophoresis
D. Test for parietal cell antibodie
108. Hemoglobinopathies are characterized by
A. Absent or reduced rate of globin-chain synthesis
B. Inability to transport and release oxygen to the tissues D. Production of structurally abnormal hemoglobin variants
C. Inhibition of iron chelation needed for heme biosynthesis
D. Production of structurally abnormal hemoglobin variants
109. Which of the following statements about hereditary sphero-
cytosis is true?
A. Abnormally shaped cells are produced in the bone marrow.
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B. Cells have a decreased mean cell hemo-globin concentration
(MCHC).
C. Membrane loss and red cell trapping oc-cur in the splenic
C. Membrane loss and red cell trapping oc-cur in the splenic
microcirculation.
microcirculation.
D. Red cell osmotic fragility is decreased.
110. Which of the following statements about hereditary elliptocy-
tosis (HE) is true?
A. Characteristic oval shape occurs in ma-ture erythrocytes.
A. Characteristic oval shape occurs in ma-ture erythrocytes.
B. Heterogeneous group of disorders linked to Rh-null individuals.
C. Cellular defect involves the lipid com-position of the membrane.
D. HE cells are abnormally permeable to calcium.
111. Which of the following disorders is com-monly linked to the
development of anemia of chronic disease?
A. Cardiovascular disease
D. Malignancy
B. Leukemoid reaction
C. Chronic gastrointestinal blood loss
D. Malignancy
112. The most appropriate screening test for detecting hemoglo-
bin F is:
A. Osmotic fragility
C. Kleihauer-Betke
B. Dithionite solubility
C. Kleihauer-Betke
D. Heat instability tes
113. Which of the following is associated with sickle cells?
A. Increased oxygen tension promotes sickling.
B. There is decreased mechanical fragility. D. Increased sickling occludes vessels.
C. There is increased deformability.
D. Increased sickling occludes vessels.
114. A bone marrow M:E ratio of 4:1 would be an expected finding
for
A. Sickle cell anemia
B. Aplastic anemia
B. Aplastic anemia
C. Beta-thalassemia major
D. Megaloblastic anemia
115. An elderly man with a 10-year history of chronic lymphocytic
leukemia pre-sented with jaundice and fatigue that was attributed
to a recent 3-gram drop in his hemoglobin. Many spherocytes
and polychromatophilic red cells were found on his Wright stained
blood smear. Which type of immune hemolytic anemia is most
B. Secondary warm autoimmune hemolytic anemia
likely?
A. Idiopathic warm autoimmune hemolytic anemia
B. Secondary warm autoimmune hemolytic anemia
C. Primary cold hemagglutinin disease
D. Paroxysmal cold hemoglobinuria
116. A person experiencing moderate anemia with suspected
pernicious anemia (PA) shows intrinsic factor antibodies and a
low cobalamin level. Which of the fol-lowing would not support the
diagnosis of PA?
A. Gastric atrophy and achlorhydria C. Bone marrow erythroid precursors ex-hibit normoblastic matu-
B. Oval macrocytes and Howell-Jolly bod-ies ration.
C. Bone marrow erythroid precursors ex-hibit normoblastic matu-
ration.
D. Elevated serum lactate dehydrogenase (LD) and bilirubin level

117. A cellulose acetate electrophoresis revealed a large band of

hemoglobin in the hemo-globin S position. This band quantified
at 95%. The peripheral smear revealed 70% target cells, and the
B. Hemoglobin D
solubility test was nega-tive. Based on this information, what is the
hemoglobin?
A. Hemoglobin C

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 B. Hemoglobin D
C. Hemoglobin E
D. Hemoglobin S
118. A previously healthy man experiences weakness and he-
moglobinuria after taking the antimalarial agent primaquine. This
he-molytic attack most likely occurred because of a deficiency of
A. Pyruvate kinase B. Glucose-6-phosphate dehydrogenase
B. Glucose-6-phosphate dehydrogenase
C. 2,3-Bisphosphoglycerate
D. Methemoglobin reductase
119. Which of the following is an acquired red cell membrane de-
fect that results in in-creased sensitivity to complement binding?
A. March hemoglobinuria
B. Paroxysmal nocturnal hemoglobinuria
B. Paroxysmal nocturnal hemoglobinuria
C. Paroxysmal cold hemoglobinuria
D. Methemoglobinemia
120. A screening test for paroxysmal nocturnal hemoglobinuria is:
A. Osmotic fragility test
B. Heat instability test C. Sucrose hemolysis
C. Sucrose hemolysis
D. Dithionite solubilit
121. Which of the following statements about the relative anemia
of pregnancy is true?
A. It is due to a reduction in the number of erythrocytes.
B. It is normocytic and normochromic.
B. It is normocytic and normochromic.
C. It produces an oxygen deficit for the fetus. D. It is associated
with a decreased in plasma volume.
122. The anemia found in chronic renal failure is most likely
caused by
A. Loss of erythropoietin synthesis
A. Loss of erythropoietin synthesis
B. Lack of cellular oxygen demand
C. Defective iron absorption
D. Destruction of red cells by uremic metabolites
123. Which of the following phrases about aplastic anemia is
false?
A. Stem cell disorder
D. Reduced red cell survival
B. Risk of life-threatening infection
C. Frequent bleeding complications
D. Reduced red cell survival
124. The fish tapeworm Diphyllobothrium latum is associated with
the development of
A. Microcytic anemia
B. Macrocytic anemia B. Macrocytic anemia
C. Hemolytic anemia
D. Hypoproliferative anemia
125. An increase in erythropoietin is not a nor-mal compensating
mechanism in which of the following conditions?
A. Renal tumors
A. Renal tumors
B. Heavy smoking
C. Cardiovascular disease
D. Pulmonary disease
126. Thalassemias are the result of a
A. Structural defect in the heme portion of hemoglobin
B. Quantitative defect in globin-chain synthesis B. Quantitative defect in globin-chain synthesis
C. Qualitative defect in globin-chain structure
D. Change in hemoglobin solubility properties
127. Which of the following characterizes iron-deficiency anemia?
A. Decreased serum iron, decreased trans-ferrin saturation, nor-
mal ferritin
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B. Decreased serum transferrin, decreased transferrin saturation,
decreased ferritin
C. Increased serum transferrin, decreased transferrin saturation, B. Decreased serum transferrin, decreased transferrin saturation,
decreased ferritin decreased ferritin
D. Increased serum transferrin, increased transferrin saturation,
decreased serum iron
128. Clinical manifestations of a homozygous mutation involving
the beta-globin gene will most likely appear
A. During embryonic development
D. By 6 months of age
B. In the neonate at birth
C. No later than 3 weeks after birth
D. By 6 months of age
129. The hemolysis associated with infection by malaria organ-
isms is due to the
A. Release of merozoites from erythrocytes
A. Release of merozoites from erythrocytes
B. Invasion of erythrocytes by merozoites
C. Host's immunologic response to infect-ed erythrocytes
D. Toxins produced by the malarial organism
130. A clinical laboratory scientist received a 5 mL EDTA tube that
contained 0.5 mL of anticoagulated blood. A smear was prepared
and stained with Wright stain. When exam-ined microscopically,
the majority of cells appeared to have many evenly distributed,
blunt spicules on the surface. How should this cellular appearance
be interpreted? D. Crenated cells caused by incorrect blood to anticoagulant ratio
A. An anemic condition requiring further testing
B. Spur cells caused by using incorrect technique during slide
preparation
C. Artifact caused by a dirty spreader slide
D. Crenated cells caused by incorrect blood to anticoagulant ratio
131. A failure to generate sufficient ATP is char-acteristic of red
blood cells with
A. Pyruvate kinase deficiency
B. Glucose-6-phosphate dehydrogenase deficiency A. Pyruvate kinase deficiency
C. Lipoprotein deficiency
D. Hexokinase deficiency
132. When iron use exceeds absorption, which of the following
occurs first?
A. Hemoglobin level decreases.
B. Iron stores are depleted. B. Iron stores are depleted.
C. Transferrin synthesis increases.
D. Excretion of iron decreases
133. The major mechanism responsible for the anemia of chronic
disease is
A. A key iron regulator called hepcidin
B. Damaged bone marrow stem cells A. A key iron regulator called hepcidin
C. Immune destruction caused by red cell autoantibodies
D. Increased erythropoietin response by committed red cell prog-
enitor cells
134. Which of the following is a characteris-tic of the idiopathic
type of sideroblastic anemia?
A. Refractory to treatment
B. Blocks in heme synthesis are readily known A. Refractory to treatment
C. Reversible with intramuscular vitamin B12 injections
D. Subtype of myelogenous leukemia

135. Thinning of bones and deformation of facial bone structure

seen in homozygous beta-thalassemia is a
B. Result of hyperplastic marrow activity
A. Consequence of disturbances in cal-cium metabolism
B. Result of hyperplastic marrow activity

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 C. Secondary disorder due to immunologic response
D. Result of increased fibroclast activity
136. Which of the following does not accurately describe cold
autoimmune hemolytic anemia?
A. Red cell agglutination in extremities induces Raynaud's phe-
nomenon.
D. The autoantibody is usually an IgG type directed against Rh
B. It may occur secondary to Mycoplasma pneumonia.
antigens
C. Hemolysis is complement-mediated or via removal of coated
cells.
D. The autoantibody is usually an IgG type directed against Rh
antigens
137. Which of the following represents an anemia that would have
a high red cell distribu-ion width (RDW)?
A. Sickle cell disease during crisis
A. Sickle cell disease during crisis
B. Thalassemia minor
C. Aplastic anemia
D. Anemia of chronic disorders
138. In which of the following disorders would splenomegaly not
be a common finding?
A. Homozygous beta-thalassemia
D. Folic acid deficiency
B. Hereditary spherocytosis
C. Hemoglobin SC disease
D. Folic acid deficiency
139. Functionally, white blood cells are divided into
A. Granulocytes, nongranulocytes
B. Polymorphonuclears, mononuclears C. Phagocytes, immunocytes
C. Phagocytes, immunocytes
D. Granulocytes, lymphocytes
140. The term "left shift" refers to:
A. A microscopic adjustment
B. Immature cell forms in the peripheral blood B. Immature cell forms in the peripheral blood
C. A trend on the Levy-Jennings chart
D. A calibration adjustment on the instrument
141. What is the approximate amount of time a granulocyte
spends in the circulation before migrating into the tissues?
A. Less than 1 day
A. Less than 1 day
B. About 3 days
C. Up to 5 days
D. More than 10 days
142. What percentage of neutrophils in the peripheral blood con-
stitutes the circulating pool?
A. 100%
C. 50%
B. 80%
C. 50%
D. 30%
143. What is the major phagocytic cell involved in the initial de-
fense against bacterial patho-gens?
A. Neutrophil
A. Neutrophil
B. Lymphocyte
C. Basophil
D. Monocyte
144. What is the growth factor that is primarily responsible for
regulating granulocyte and monocyte production?
A. Erythropoietin
B. Colony stimulating factor B. Colony stimulating factor
C. Interleukin
D. Thrombopoietin
145. What does the granulocyte mitotic pool in the bone marrow
contain?
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 A. Myeloblasts and promyelocytes
B. Band and segmented forms
A. Myeloblasts and promyelocytes
C. The majority of marrow granulocytes
D. Myelocytes and metamyelocytes
146. Cells that produce antibodies and lymphokines are:
A. Erythrocytes
B. Granulocytes C. Lymphocytes
C. Lymphocytes
D. Thrombocytes
147. Which of the following is characteristic of agranulocytosis in
the peripheral blood and bone marrow?
A. Neutrophils without granules
D. Decreased numbers of granulocytes
B. Decreased numbers of granulocytes, red cells, and platelets
C. Immature granulocytes in the peripheral blood
D. Decreased numbers of granulocytes
148. Which of the following is a characteristic of T lymphocytes?
A. Produce B Cells
B. Stimulate leukopoiesis C. Comprise majority of cells in the blood lymphocyte pool
C. Comprise majority of cells in the blood lymphocyte pool
D. Regulate the immune respons
149. An adult has a total white blood cell count of 4.0 * 109/L
14.0 * 103/¼L 2. The dif-ferential count is as follows: polymorpho-nu-
clear neutrophils (PMNs) 25%, bands 5%, lymphocytes 65%, and
monocytes 5%. The absolute value reference range for lympho-
cytes is 1.0-4.0 * 109/L. Which of the following is true? C. There is a relative lymphocytosis.
A. The percentage of lymphocytes is nor-mal.
B. There is an absolute lymphocytosis.
C. There is a relative lymphocytosis.
D. There is both an absolute and a relative lymphocytosis
150. Which of the following statements is correct?
A. Hypersegmented neutrophils have four nuclear lobes.
B. Auer rods are composed of fused pri-mary (nonspecific) gran- B. Auer rods are composed of fused pri-mary (nonspecific) gran-
ules. ules.
C. Toxic granules are prominent secondary granules.
D. Döhle bodies are agranular patches of DNA.
151. Which of the following factors is not associ-ated with varia-
tions in the total white blood cell count?
A. Age
D. Sex
B. Exercise
C. Emotional stress
D. Sex
152. Of the following, an absolute neutrophil count of 1.0 * 109/L
would be associated with
A. Shortness of breath
C. Risk of infection
B. Bleeding tendencies
C. Risk of infection
D. No clinical symptoms
153. Which of the following statements about basophils is true?
A. Morphologically, basophils resemble mott cells.
B. Membrane receptors bind IgG, initiating anaphylactic reactions. C. Basophilic granules contain heparin and histamine.
C. Basophilic granules contain heparin and histamine.
D. Granules are non-water soluble
154. The most mature granulocyte precursor that can undergo
mitosis is the
A. Myeloblast
C. Myelocyte
B. Promyelocyte
C. Myelocyte
D. Band

17 / 35
 155. Production of primary granules ceases and production of
secondary granules commences with what cell stage?
A. Myeloblast
C. Myelocyte
B. Promyelocyte
C. Myelocyte
D. Metamyelocyte
156. Which of the following statements about eosinophils is true?
A. They contain a type of peroxidase that is distinct from that of
neutrophils. A. They contain a type of peroxidase that is distinct from that of
B. Eosinophilic granules contain lysozyme. neutrophils.
C. Eosinophils are an important line of defense against bed sores
D. Major basic protein is a component of sederotic granules
157. Which of the following is characteristic of secondary gran-
ules?
A. Coated with a phospholipid membrane
B. Called specific granules appearing in the myelocyte stage
B. Called specific granules appearing in the myelocyte stage
C. Contain myeloperoxidase, lysozyme, and acid phosphatase
D. Present in the promyelocyte stage only
158. The peripheral blood monocyte is an inter-mediate stage in
the formation of the:
A. Plasmacyte
C. Fibroblast
B. Osteoclast
C. Fibroblast
D. Hairy cel
159. What is the term for cell movement through blood vessels to
a tissue site?
A. Diapedesis
A. Diapedesis
B. Opsonization
C. Margination
D. Chemotaxis
160. Vasodilation and bronchoconstriction are the result of de-
granulation by which of the following blood cells?
A. Eosinophils
D. Basophils
B. Monocytes
C. Neutrophils
D. Basophils
161. Multipotent stem cells are capable of pro-ducing
A. Daughter cells of only one cell line
B. Only T Lymphocytes and B Lymphocytes D. Lymphoid and myeloid stem cells
C. Erythropoietin, thrombopoietin, and leukopoietin
D. Lymphoid and myeloid stem cells
162. Cells that provide cellular (cell mediated) immunity are:
A. Natural killer cells
B. T lymphocytes B. T lymphocytes
C. Virocytes
D. Thymocytes
163. Which of the following statements about neutrophils is true?
A. Suppress allergic reactions caused by basophils
B. Have surface receptors for IgM and complement components
C. Contain alkaline phosphatase and muramidase
C. Contain alkaline phosphatase and muramidase
D. Act in specific phagocytosis and are destined to live for a long
time
164. Which of the following characteristics would be least likely to
distinguish reactive lymphocytes from monocytes?
A. Sharp indentation of the cytoplasmic margin by adjacent red
blood cells C. Irregular, indented nuclear shape
B. Presence of large azurophilic granules
C. Irregular, indented nuclear shape
D. Abundant, deeply basophilic cytoplasm

18 / 35
165. Which of the following can differentiate a metamyelocyte from
a band?
A. Presence of specific granules
B. Indentation of nucleus less than 50%
B. Indentation of nucleus less than 50%
C. Absence of nucleoli
D. Color of cytoplasm
166. Lymphocyte concentrations in the peripheral blood are great-
est during what age interval?
A. 1 to 4 years
A.1 to 4 years
B. 4 to 15 years
C. 16 to 40 years
D. 40 to 70 years
167. Which of the following is the least likely to be expressed by
early B cell precursors?
A. SIgM, a surface membrane immuno-globulin
B. CD34, a hematopoietic stem cell marker A. SIgM, a surface membrane immuno-globulin
C. TdT (terminal deoxynucleotidyl trans-ferase), a nuclear en-
zyme
D. CD10 (CALLA), a surface antige
168. Which of the following statements about macrophages is
correct?
A. They are mature tissue forms of blood lymphocytes.
B. They serve as antigen-presenting cells to the immune system. B. They serve as antigen-presenting cells to the immune system.
C. Their quantity of lysosomes and acid hydrolases decreases
during maturation.
D. They are not active in removing cellular debris
169. Antigen-dependent lymphopoiesis occurs in secondary lym-
phoid tissue located in the
A. Liver and kidney
B. Spleen and lymph nodes
B. Spleen and lymph nodes
C. Lungs and Peyer's patches
D. Thymus and bone marrow
170. Which of the following is associated with pseudo-Pelger-Huet
anomaly?
A. Aplastic anemia
C. Myelogenous leukemia
B. IDA
C. Myelogenous leukemia
D. Chediak-Higashi syndrone
171. In patients with infectious mononucleosis, which blood cells
are infected by which causative agent?
A. Monocytes
B. T lymphocytes C. B lymphocytes
C. B lymphocytes
D. Histiocytes
172. Which of the following statements about hairy cell leukemia
is true?
A. It is an acute disease, primarily affecting young adults.
B. Splenomegaly is an unusual finding. C. Hairy cells contain tartrate-resistant acid phosphatase.
C. Hairy cells contain tartrate-resistant acid phosphatase.
D. Hairy cells are abnormal T lymphocytes.
173. Based on the WHO classification system, B cell ALL (FAB
type L3) and represent different clinical presentations of
the same disease entity.
A. Burkitt lymphoma A. Burkitt lymphoma
B. Hodgkin lymphoma
C. mycosis fungoides
D. small lymphocytic lymphom
174. Biochemical abnormalities characteristic of polycythemia
vera include:
19 / 35
 A. Increased serum B12 binding capacity
B. Hypouricemia
A. Increased serum B12 binding capacity
C. Hypohistaminemia
D. Decreased LAP activit
175. In which anomaly is a failure of granulo-cytes to divide
beyond the band or two-lobed stage observed?
A. Pelger-Huët
A. Pelger-Huët
B. May-Hegglin
C. Alder-Reilly
D. Chédiak-Higashi
176. In which of the following are eosinophils decreased?
A. Cushing syndrome
B. Allergic disorders A. Cushing syndrome
C. Skin disorders
D. Parasitic infection
177. Which of the following represents the principal defect in
chronic granulomatous disease (CGD)?
A. Chemotactic migration
D. Oxidative respiratory burst
B. Phagocytosis
C. Lysosomal formation and function
D. Oxidative respiratory burst
178. The blood shown in Color Plate 11 is from a patient with
leukemia following treatment. These findings are most sugges-tive
of therapy with
A. Corticosteroids (e.g., prednisone) B. A folate antagonist (e.g., methotrexate)
B. A folate antagonist (e.g., methotrexate)
C. Recombinant erythropoietin
D. Chloramphenicol
179. A patient with normal hemoglobin and WBC count val-
ues, a persistently elevated platelet count (over 1000 * 109/L),
in-creased marrow megakaryocytes, and a history of frequent
bleeding and clotting episodes most likely has A. Polycythemia
C. Essential thrombocythemia
vera
B. Chronic myelofibrosis
C. Essential thrombocythemia
D. Chronic myelogenous leukemia
180. An adult patient with massive splenomegaly has mild anemia,
a slightly elevated WBC count, and an LAP score of 10. These
find-ings are most consistent with
A. Chronic myelogenous leukemia A. Chronic myelogenous leukemia
B. Idiopathic myelofibrosis
C. Primary polycythemia
D. Primary thrombocythemia
181. Which of the following infections does not reveal a blood
picture as seen in Color Plate 12 ?
A. Epstein-Barr virus (EBV)
B. Bordetella pertussis (whooping cough)
B. Bordetella pertussis (whooping cough)
C. Cytomegalovirus (CMV)
D. Toxoplasma gondii (toxoplasmosis)
182. A rare and more aggressive type of chronic lymphocytic
leukemia (CLL) in the United States involves the
A. B cell
B. NK cell C. T cell
C. T cell
D. Plasma cell
183. Which of the following are characteristic findings in Walden-
ström disease?
A. Increased IgA and hepatosplenomegaly D. Increased IgM and blood hyperviscosity
B. Increased IgE and renal failure
20 / 35
 C. Increased IgG and bone fracture
D. Increased IgM and blood hyperviscosity
184. Which of the following would not cause a total WBC count of
62.2 * 109/L 162.2 * 1 0 3 / ¼
L 2 and the blood findings seen in Color
Plate 13 ?
A. Treatment with myeloid growth factors C. Human immunodeficiency virus (HIV)
B. Gram-negative septicemia
C. Human immunodeficiency virus (HIV)
D. Systemic fungal infection
185. In which of the following is progression to acute leukemia
least likely?
A. Chronic myelogenous leukemia (CML)
B. Refractory anemia with excess blasts (RAEB)
B. Refractory anemia with excess blasts (RAEB)
C. Refractory anemia with ringed sidero-blasts (RARS)
D. Chronic lymphocytic leukemia (CLL)
186. The peripheral blood shown in Color Plate 14 is from a
69-year-old female. Her WBC count was 83.0 * 109cells/L 183.0 *
10 3/¼L 2 and her platelet count was normal. Based on the cell mor-
phology and this information, what is the most likely diagnosis?
D. Viral infection
A. Acute lymphoblastic leukemia
B. Chronic lymphocytic leukemia
C. Waldenström macroglobulinemia
D. Viral infection
187. A Gaucher cell is best described as a macrophage with
A. "Wrinkled" cytoplasm due to an accu-mulation of glucocerebro-
side
A. "Wrinkled" cytoplasm due to an accu-mulation of glucocerebro-
B. "Foamy" cytoplasm filled with unme-tabolized sphingomyelin
side
C. Pronounced vacuolization and deposits of cholesterol
D. Abundant cytoplasm containing storage iron and cellular rem-
nants
188. Which of the following suggests a diagnosis of Hodgkin
disease rather than other lymphoproliferative disorders?
A. Presence of a monoclonal population of large lymphoid cells
D. Presence of giant binucleated Reed-Sternberg cells with promi-
B. Predominance of immature B cells with irregular nuclear clefts
nent nucleoli
C. Circulating T cells with a convoluted, cerebriform nucleus
D. Presence of giant binucleated Reed-Sternberg cells with
prominent nucleoli
189. The M:E ratio in acute myelocytic leukemia is usually
A. Normal
B. High B. High
C. Low
D. Variable
190. The presence of the chromosomal abnor-mality t(15;17) and
a high incidence of dis-seminated intravascular coagulation (DIC)
is diagnostic of
A. Acute myeloblastic leukemia without maturation (FAB type M1) C. Acute promyelocytic leukemia (FAB type M3)
B. Acute myeloblastic leukemia with matu-ration (FAB type M2)
C. Acute promyelocytic leukemia (FAB type M3)
D. Acute myelomonocytic leukemia (FAB type M4)
191. Which of the following is not commonly found in acute myel-
ogenous leukemias?
A. Neutropenia
D. Lymphadenopathy
B. Thrombocytopenia
C. Hepatosplenomegaly
D. Lymphadenopathy
192. The child whose blast cells are shown in Color Plate 15 has
acute lymphoblastic leukemia that is precursor B cell type and
CALLA positive. Analysis by flow cytom-etry would likely show
cells that immuno-phenotype for
21 / 35
 A. CD2, CD7
B. CD10, CD19
B. CD10, CD19
C. CD13, CD33
D. CD14, CD34
193. The patient whose bone marrow is shown in Color Plate 16
most likely has a(n)
A. Acute leukemia
A. Acute leukemia
B. Chronic leukemia
C. Myelodysplastic syndrome
D. Aplastic anemia
194. Multiple myeloma is characterized by the presence in urine
and serum of
A. Cryoglobulins
C. M spike on protein electrophoresis
B. IgG heavy chains
C. M spike on protein electrophoresis
D. Beta microglobulins
195. Which of the following is not classified as a myeloproliferative
disorder?
A. Polycythemia vera
C. Multiple myeloma
B. Essential thrombocythemia
C. Multiple myeloma
D. Chronic myelogenous leukemia
196. Which of the following gene mutations correlates with the
t(9;22) that is present in Philadelphia chromosomepositive chronic
myelogenous leukemia?
A. MYC/IGH B. BCR/ABL
B. BCR/ABL
C. PML/RARA
D. JAK2
197. Which of the following statements cor-rectly describes the
WHO (World Health Organization) classification of hematopoi-etic
neoplasms?
A. Acute leukemia is defined as the pres-ence of at least 5% bone
C. It groups lymphoid disorders into B cell, T/NK cell, and Hodgkin
marrow blasts.
lym-phoma.
B. Diagnosis is based on cellular morphol-ogy and cytochemistry.
C. It groups lymphoid disorders into B cell, T/NK cell, and Hodgkin
lym-phoma.
D. Diagnostic criteria include PCR testing features
198. Which of the following would be helpful in distinguishing
chronic myelogenous leuke-mia (CML) from a neutrophilic leuke-
moid reaction?
A. An extreme leukopenia with increased neutrophilic bands,
B. Leukocyte alkaline phosphatase score
metamyelocytes, and myelocytes
B. Leukocyte alkaline phosphatase score
C. Presence of a normal spleen
D. Monocytes with Döhle bodies and toxic granulation
199. The cytoplasmic inclusion present in the cell shown in Color
Plate 17
A. Excludes a diagnosis of acute myelog-enous leukemia
C. Stains positive with myeloperoxidase (MPO)
B. Stains positive with leukocyte alkaline phosphatase (LAP)
C. Stains positive with myeloperoxidase (MPO)
D. Identifies the cell as a malignant lym-phoblast
200. 50-90, myeloblasts in a peripheral blood is typical of which of
the following?
A. CML
C. Erythroleukemia
B. MMM
C. Erythroleukemia
D. AML

22 / 35
 201. In what condition would a LAP score be elevated?
A. Viral infection
B. Late pregnancy B. Late pregnancy
C. Decreased red cell count
D. Chronic myelogenous leukemia
202. Which of the following is associated with neutrophilia?
A. Cirrhosis
B. Infectious mononucleosis D. Neoplasms (tumors
C. Infectious hepatitis
D. Neoplasms (tumors
203. In which of the following would an abso-lute monocytosis be
seen?
A. Tuberculosis
A. Tuberculosis
B. Recovery stage of non-acute bacterial infection
C. Hemolytic disorders
D. Infectious mononucleosis
204. Coarse PAS positivity may be found in the leukemic cells of
A. Acute myeloblastic leukemia (FAB type M1)
B. Acute lymphoblastic leukemia (FAB type L1) B. Acute lymphoblastic leukemia (FAB type L1)
C. Acute myelomonocytic leukemia (FAB type M4)
D. Acute monocytic leukemia (FAB type M5
205. Which of the following are among the diagnostic criteria used
for classifying the myelodysplastic syndromes?
A. Unexplained anemia of chronic dis-ease
C. Abnormal platelet size and granulation
B. Hypergranular and hypersegmented neutrophils
C. Abnormal platelet size and granulation
D. Hypocellular bone marrow with 25% blast
206. Naphthol AS-D chloroacetate esterase (specific) is usually
positive in cells, and alpha-naphthyl acetate esterase
(nonspecific) is useful for identifying blast cells of lin-
eage.
A. granulocytic; monocytic
A. granulocytic; monocytic
B. monocytic; granulocytic
C. granulocytic; lymphocytic
D. monocytic; lymphocytic
207. The familial disorder featuring pseudo-Döhle bodies, throm-
bocytopenia, and large platelets is called
A. May-Hegglin anomaly
A. May-Hegglin anomaly
B. Chédiak-Higashi syndrome
C. Pelger-Huët anomaly
D. Alder-Reilly anomaly
208. Alder-Reilly anomaly is an abnormality of
A. Lysosomal fusion
B. Nuclear maturation D. Mucopolysaccharide metabolism
C. Oxidative metabolism
D. Mucopolysaccharide metabolism
209. What is the initial laboratory technique for the diagnosis of
monoclonal gammopa-thies?
A. Immunologic markers of marrow bi-opsy cells
C. Serum and urine protein electrophoresis
B. Cytochemical staining of marrow and peripheral blood cells
C. Serum and urine protein electrophoresis
D. Cytogenetic analysis of marrow cells
210. Which of the following statements about Hodgkin disease is
false?
A. Peak incidence occurs in young adults.
B. Staging determines extent of disease and treatment course. C. Stage IV has the best prognosis.
C. Stage IV has the best prognosis.
D. Almost a 2:1 male predominance over females is characteristic

23 / 35
211. The blast cells shown in Color Plate 18 are CD14 and CD33
positive, Sudan black B positive, specific esterase positive, and
nonspecific esterase positive. Which type of acute leukemia is
most consistent with the immunophenotyping and cytochemical
staining results? C. Acute myelomonocytic leukemia
A. Acute lymphoblastic leukemia, T cell type
B. Acute erythroleukemia
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia
212. Which type of leukemia is associated with the best prognosis
for a cure?
A. Chronic lymphocytic leukemia in the elderly
B. Acute lymphoblastic leukemia in chil-dren
B. Acute lymphoblastic leukemia in chil-dren
C. Acute myelogenous leukemia in chil-dren
D. Chronic myelogenous leukemia in young adults
213. What is the key diagnostic test for Hodgkin lymphoma?
A. Bone marrow biopsy
B. Lymph node biopsy B. Lymph node biopsy
C. Spinal tap
D. Skin biopsy
214. A bone marrow with 90% cellularity and myeloid:erythroid
(M:E) ratio of 10:1 is most characteristic of
A. Chronic myelogenous leukemia
A. Chronic myelogenous leukemia
B. Primary polycythemia
C. Beta-thalassemia major
D. Aplastic anemia
215. A 60-year-old patient presents with extreme fatigue. Her
blood and bone marrow find-ings are as follows: severe anemia
with a dual RBC population, 3% marrow blasts, and numerous
ringed sideroblasts. This information is most consistent with
A. Refractory anemia (RA) B. Refractory anemia with ringed sidero-blasts (RARS)
B. Refractory anemia with ringed sidero-blasts (RARS)
C. Refractory anemia with excess blasts (RAEB) D. Chronic
myelomonocytic leukemia (CMML)
216. Which of the following is not a mechanism by which neu-
tropenia may be produced?
A. Hypersplenism
B. Marrow injury or replacement C. Recent strenuous exercise
C. Recent strenuous exercise
D. Drug-induced antibodies
217. Which of the following is a characteristic findings in poly-
cythemia vera?
A. Blood cytopenia
B. Increased red cell mass B. Increased red cell mass
C. Increased erythropoietin level
D. decreased blood viscosity
218. In what disorder is significant basophilia most commonly
seen?
A. Hairy cell leukemia
B. Plasma cell leukemia D. Chronic myelogenous leukemia
C. Acute lymphoblastic leukemia
D. Chronic myelogenous leukemia
219. Acute erythroleukemia (FAB type M6) is characterized by
increased
A. Promyelocytes and lysozyme activity
B. Marrow megakaryocytes and thrombo-cytosis C. Marrow erythroblasts and multinucle-ated red cells
C. Marrow erythroblasts and multinucle-ated red cells
D. Marrow monoblasts and immature monocyte

24 / 35
 220. The blood findings present in Color Plate 20 are from a
patient with complaints of fatigue and severe lower back pain.
Which of the fol-lowing would not be typical of this disease?
A. Bone tumors of plasma cells D. Normal sedimentation rate
B. Hypercalcemia
C. Progressive renal impairment
D. Normal sedimentation rate
221. Myeloid metaplasia refers to
A. Displacement of normal marrow cells by fibrous tissue
B. Hematopoietic failure C. Extramedullary hematopoiesis
C. Extramedullary hematopoiesis
D. Tumors (neoplasms) of the bone mar-row
222. Which of the following statements about non-Hodgkin types
of lymphoma is true?
A. Lymphadenopathy is the most common presenting symptom.
B. Initially, they present as a systemic dis-ease rather than a
A. Lymphadenopathy is the most common presenting symptom.
localized tumor.
C. They are often associated with multiple bone lesions.
D. They are characterized by proliferation of malignant cells pri-
marily involving the bone marrow.
223. What combination of reagents is used to measure hemoglo-
bin?
A. Hydrochloric acid and p-dimethylaminobenzaldehyde
B. Potassium ferricyanide and potassium cyanide
B. Potassium ferricyanide and potassium cyanide
C. Sodium bisulfite and sodium metabisulfite
D. Sodium citrate and hydrogen peroxide
224. The slowest-moving hemoglobin(s) on an alkaline elec-
trophoresis at pH 8.6 is(are)
A. A
B. A2, C, E, and O
B. A2, C, E, and O
C. F
D. S, D, and G
225. A patient with suspected sickle cell trait has negative solubil-
ity test results, but hemoglo-bin electrophoresis at pH 8.6 shows
an ap-parent A-S pattern. What is the most likely explanation?
A. Patient has hemoglobin AS, and the solubility test is incorrect.
B. Patient has hemoglobin AA, and the electrophoresis is incor- C. Patient has hemoglobin AD or AG, and both procedures are
rect. correct.
C. Patient has hemoglobin AD or AG, and both procedures are
correct.
D. Tests need to be repeated; impossible to determine which
procedure is correct.
226. Which of the following is an incorrect state-ment about the
solubility test for Hemoglo-bin S?
A. Hemoglobin S polymerizes when de-oxygenated.
B. Testing performed on a 2-day-old infant can result in a C. Sickle cell trait can be differentiated from sickle cell anemia with
false-negative result. this test.
C. Sickle cell trait can be differentiated from sickle cell anemia with
this test.
D. The test is positive in hemoglobin CHarlem
227. Which of the following is not associated with causing a falsely
low ESR?
A. Column used is slanted.
B. EDTA tube is clotted. A. Column used is slanted.
C. EDTA tube is one-third full.
D. EDTA specimen is 24 hours old.

228. A platelet count is performed on an automated instrument

from an EDTA blood sample. Smear evaluation reveals the pres-
ence of platelet clumps. The specimen is redrawn using sodium

25 / 35
citrate as the anticoagulant, and a count of 300 * 109/L is obtained.
What is the correct platelet count to report?
A. 270 * 109/L
C. 330 * 109/L
B. 300 * 109/L
C. 330 * 109/L
D. 360 * 109/L
229. To best preserve cellular morphology, dif-ferential smears
from an EDTA specimen should be made no more than
hour(s) after collection.
A. 1 B. 5
B. 5
C. 12
D. 24
230. The blood smear made on a patient with polycythemia vera
is too short. What should be done to correct this problem?
A. Decrease the angle of the spreader slide.
A. Decrease the angle of the spreader slide.
B. Increase the angle of the spreader slide.
C. Adjust the angle of the spreader slide to 45 degrees.
D. Use a smaller drop of blood.
231. The components of Wright stain include
A. Crystal violet and safranin
B. Brilliant green and neutral red D. Methylene blue and eosin
C. New methylene blue and carbolfuchsin
D. Methylene blue and eosin
232. What is the reason for red blood cells to be bright red and the
WBC nuclei to be poorly stained when using Wright's stain?
A. The staining time is too long.
C. The stain or buffer is too acidic.
B. The stain or buffer is too alkaline.
C. The stain or buffer is too acidic.
D. The smear was not washed long enough.
233. If 60 reticulocytes are counted in 1000 red blood cells, what
is the reticulocyte count? C. 6.0%
A. 0.06%
Number of reticulocytes counted/ Total number of RBCs counted
B. 0.6%
* 100
C. 6.0%
D. 60.0%
234. Using the percent reticulocyte from question 233 and an RBC
count of 3.00 * 1012/L 13.00 * 1 0 6 /¼
L 2 , the cal-culated absolute
reticulocyte count reported in SI units is
A. 1.8 * 109/L C. 180 * 109/L
B. 18 * 109/L
C. 180 * 109/L
D. 180 * 103/L¼
235. The Sudan black B stain shown in Color Plate 19 is a stain
for
A. Glycogen
B. Lipids
B. Lipids
C. Myeloperoxidase
D. Acid phosphatase
236. The following numbers were obtained in evaluating leukocyte
alkaline phosphatase (LAP) activity in neutrophils. What is the
score?
0-15, 1-20, 2-30, 3-20, 4-15
C. 200
A. 100
B. 115
C. 200
D. 215
237. Perl's Prussian blue is a stain used to detect
A. DNA
26 / 35
 B. RNA
C. Iron C. Iron
D. Glycogen
238. Which of the following red cell inclusions stain with both Perl's
Prussian blue and Wright's stain?
A. Howell-Jolly bodies
C. Pappenheimer bodies
B. Basophilic stippling
C. Pappenheimer bodies
D. Heinz bodies
239. What is the depth between the counting platform and the
coverslip on a hemacy-tometer?
A. 0.01 mm
B. 0.10 mm
B. 0.10 mm
C. 1.00 mm
D. 0.1 cm
240. A WBC count is performed on a hemacy-tometer using a 1:20
dilution. 308 cells are seen in a total area of 8 mm2. What is the
WBC count?
A. 3.8 * 109/L B. 7.7 * 109/L
B. 7.7 * 109/L
C. 15.4 * 109/L
D. 38.5 * 109/L
241. Which set of results indicates that an error in measurement
has occurred?
RBC Hgb Hct
A. 2.50 7.6 22.9 B. 2.75 9.5 24.8
B. 2.75 9.5 24.8
C. 3.40 10 31
D. 3.75 11.1 34.0
242. Which of the following would not be the cause of a falsely
high MCHC of 38.3 g/dL on an automated instrument?
A. Hereditary spherocytosis
A. Hereditary spherocytosis
B. Lipemia
C. Presence of a cold agglutinin
D. Instrument sampling or mixing error
243. What is the principle of automated impedance cell counters?
A. Angle of laser beam scatter by cells
B. Amplification of an electrical current by cells C. Interruption of an electrical current by cells
C. Interruption of an electrical current by cells
D. Change in optical density of the solu-tion containing cell
244. A clinically significant difference between two electronic cell
counts is indicated when the standard deviation is greater than
A. { 1.0
C. {2.0
B. {1.5
C. {2.0
D. {3.0
245. Forward angle scatter in a laser-based cell counting system
is used to measure
A. Relative cell size
A. Relative cell size
B. Cytoplasmic granularity
C. Cell number
D. Immunologic (antigenic) identification
246. A white blood cell count is done on an automated impedance
cell counter from a patient with the blood picture seen in Color
Plate 4 . The WBC count is most likely
A. Falsely increased because of nRBCs A. Falsely increased because of nRBCs
B. Falsely increased because of red cell fragments
C. Falsely decreased because of nRBCs
D. Accurate; no error with this methodology

27 / 35
 247. The hemoglobin A2 quantification using anion exchange
chromatography will be valid in
A. Hemoglobin C disease
D. Beta-thalassemia minor
B. Hemoglobin E trait
C. Hemoglobin O trait
D. Beta-thalassemia minor
248. Which of the following is associated with a decreased osmotic
fragility and an increased surface area-to-volume ratio?
A. Beta-thalassemia major
C. Target cells associated with thalassemias
B. Hereditary spherocytosis
C. Target cells associated with thalassemias
D. Burn victims
249. A clotted EDTA tube can falsely affect which tests except?
A. Erythrocyte sedimentation rate
B. Solubility test for hemoglobin S B. Solubility test for hemoglobin S
C. Hematocrit
D. Platelet count
250. The test value range that includes 95% of the normal popu-
lation is the
A. Reference interval
A. Reference interval
B. Linearity limit
C. Reportable range
D. Critical range
251. To establish a standard curve for reading hemoglobin con-
centration,
A. A commercial control material is used.
B. A wavelength of 640 nm is employed. C. Certified standards are used.
C. Certified standards are used.
D. A patient blood sample of known he-moglobin concentration is
used.
252. Which of the following is a source of error when measuring
hemoglobin by the cyan-methemoglobin method?
A. Excessive anticoagulant
B. White blood cell count that exceeds linearity limits
B. White blood cell count that exceeds linearity limits
C. Sodium citrate plasma
D. Clear glass hemoglobin measuring cel
253. Which of the following statements about microhematocrits is
false?
A. Improper sealing of the capillary tube causes an increase in Hct
A. Improper sealing of the capillary tube causes an increase in Hct
readings as a result of loss of blood during centrifugation.
readings as a result of loss of blood during centrifugation.
B. A tube less than half full causes falsely low results.
C. Hemolysis causes falsely low results.
D. Trapped plasma causes falsely high results.
254. The erythrocyte sedimentation rate (ESR) is influenced by
the red cell phenomenon seen in Color Plate 20 . Which of the
fol-lowing factors will neither contribute to this phenomenon nor
affect the ESR?
C. Hemoglobin content of the red blood cells
A. Size of the red blood cells
B. Shape of the red blood cells
C. Hemoglobin content of the red blood cells
D. Composition of the plasm
255. An EDTA blood sample run on an auto-mated impedance cell
counter has generat-ed a warning flag at the upper region of the
platelet histogram illustrated below. Which of the following would
not be a cause of this warning flag?
A. Nucleated RBCs
A. Nucleated RBCs
B. Microcytic RBCs
C. EDTA-dependent platelet agglutinins
D. Giant platelets

28 / 35
256. To evaluate normal platelet numbers in an appropriate area
of a blood smear, ap-proximately how many platelets should be
observed per oil immersion field?
A. 1-4 C. 8-20
B. 4-10
C. 8-20
D. 20-50
257. Which of the following statements about manual reticulocyte
counts is true?
A. The blood/stain mixture is incubated for 5-10 minutes.
B. New Prussian blue, a supravital stain, is used. C. RBC inclu- A. The blood/stain mixture is incubated for 5-10 minutes.
sions can result in falsely decreased counts.
D. An erythrocyte must have at least four blue particles to be
counted as a reticu-locyte.
258. When are automated cell counters required to have a cali-
bration check per-formed?
A. At least every 3 months
B. After replacement of any major part B. After replacement of any major part
C. After performing monthly maintenance
D. When the control values are greater than two standard devia-
tions from the mean
259. A blood sample was run through an auto-mated cell counter
and the following results were obtained: WBC 6.9 * 109/L (6.9
* 103/mL), RBC 3.52 * 1012/L (3.52 * 106/ mL), Hgb 120 g/L
(12.0 g/dL), Hct 0.32 L/L (32.0%), MCH 34.1 pg, MCHC 37.5
g/dL. Which of the troubleshooting steps that follows should be
A. Perform a saline replacement proce-dure.
performed to obtain reportable results?
A. Perform a saline replacement proce-dure.
B. Warm the specimen to 37°C and rerun.
C. Perform a microhematocrit.
D. None; the results are reportable.
260. Which of the following tests could be per-formed on a he-
molyzed blood sample?
A. Hemoglobin only
B. Hemoglobin and platelet count A. Hemoglobin only
C. RBC count and hematocrit
D. No results would be reportable.
261. For which of the following procedures would heparin be a
recommended antico-agulant?
A. Platelet count
B. Coagulation tests D. Osmotic fragility
C. Smear-based red cell morphology
D. Osmotic fragility
262. In the platelet count procedure using phase microscopy,
A. Platelets appear dark against a light background.
B. The entire ruled counting surface of the hemacytometer is
used. A. Platelets appear dark against a light background.
C. Ammonium oxalate will lyse the WBCs.
D. Platelets should be counted immediate-ly after plating on the
hemacytometer
263. What is the quality control term used to describe the repro-
ducibility of a test?
A. Accuracy
B. Precision B. Precision
C. Standard deviation
D. Specificity

(264-268) The peripheral blood shown in Color Plate 4 is from a

10-month-old greek boy with the following results on an automated
impedance counter: WBC 35.0 * 109/L 135.0 * 10 3/¼ L 2; RBC 2.50

29 / 35
* 1012/L 12.50 * 106/¼L 2; hemoglobin 45 g/L (4.5 g/dL); hematocrit
0.16 L/L (16%); platelet count250 * 109/L 1250,000/¼ L 2; reticulo-
cyte count 8.0%; 110 nucleated red blood cells/100 WBCs and
many targets are seen. Other laboratory results are as follows:
serum iron elevated; total iron-binding capacity (TIBC) decreased;
serum ferritin elevated.
C. 16.7
What is the corrected white blood cell count expressed in SI units
of *109/L?
A. 4.6
B. 12.5
C. 16.7
D. 18.4
265. What would be the appearance of the child's red blood cells
on a peripheral smear?
A. Microcytic, hypochromic
A. Microcytic, hypochromic
B. Normocytic, hypochromic
C. Normocytic, normochromic
D. Microcytic, normochromic
266. The CBC, serum iron, total iron-binding capacity, and serum
ferritin levels are most characteristic of
A. Beta-thalassemia minor
D. Beta-thalassemia major
B. Iron-deficiency anemia
C. Alpha-thalassemia minor
D. Beta-thalassemia major
267. What type(s) of hemoglobin will be detect-ed on this child
using hemoglobin electro-phoresis?
A. A only
D. F only
B. A and F
C. A, increased A2, F
D. F only
268. Why is it difficult to diagnose this disorder in a newborn?
A. The liver is immature.
B. The beta chains are not fully developed at birth.
C. It is similar to hemolytic disease of the newborn (HDN) because B. The beta chains are not fully developed at birth.
of ABO incompatibility.
D. There are normally many erythrocyte precursors in the periph-
eral blood
(269-271) A 75-year-old man with rheumatoid ar-thritis complains
to his physician of pain and fatigue. His CBC results are as follows:
WBC 6.8 * 109/L 16.8 * 103/¼ L 2; RBC 3.49 * 1012/L 13.49 * 106/¼L2;
hemoglo-bin 97 g/L (9.7 g/dL); hematocrit 0.29 L/L (29%); MCV
83 fL; MCHC 33.9 g/dL. Other laboratory results are as follows:
serum iron and total iron-binding capacity (TIBC) both decreased,
serum ferritin slightly elevated. D. 15%
If the serum iron is 22 mg/dL and the TIBC is 150 mg/dL, what is
the percent transferrin?
A. 7%
B. 10%
C. 12%
D. 15%
270. The results of the CBC and iron studies in this case are most
characteristic of
A. Beta-thalassemia minor
B. Iron deficiency D. Anemia of chronic disease
C. Sideroblastic anemia
D. Anemia of chronic disease
271. Which of the following is not associated with the anemia
described in question 270?
A. Chronic gastrointestinal blood loss A. Chronic gastrointestinal blood loss
B. Hodgkin lymphoma
30 / 35
 C. Tuberculosis
D. Systemic lupus erythematosus
(272-274) The peripheral blood shown in Color Plate 11 is from a
19-year-old female col-lege student who has been living primar-ily
on tea, beer, and cereal for the past 9 months because she finds
dining hall food distasteful. She visits student health com-plaining
of fatigue. Her CBC results are as follows: WBC 2.5 * 109/L 12.5
* 103/¼ L 2; RBC 2.10 * 1012/L 12.10 * 106/¼ L 2; hemoglobin 85 g/L
(8.5 g/dL); hema-tocrit 0.24 L/L (24%); platelet count 110 * 109/L
1110,000/¼ L 2; MCV 114 fL; MCHC 35.0 g/dL; reticulocyte count A. Vitamin B12 and folate levels
0.8%.
What test(s) should be done first to deter-mine a diagnosis in this
patient?
A. Vitamin B12 and folate levels
B. Iron studies
C. Bone marrow examination
D. Osmotic fragility
273. In the absence of neurological symptoms, the anemia in this
patient is most likely caused by a lack of
A. An enzyme
B. Iron C.Folic acid
C. Folic acid
D. Intrinsic factor
274. Which of the following is not a laboratory finding in this
general classification of anemia?
A. Target cells and schistocytes
A. Target cells and schistocytes
B. Teardrop cells and macro-ovalocytes
C. Howell-Jolly bodies and Cabot rings
D. Elevated serum LD and iron level
(275-277) A 45-year-old Scandinavian woman with white hair
appears older than her age. She complains to her physi-cian of
weakness, a tingling sensation in her lower extremities, and short-
ness of breath. Her CBC results are as follows: WBC 3.4 * 109/L
13.4 * 10 3/¼L 2; RBC 1.90 * 1012/L 11.90 * 106/ ¼
L 2; hemoglobin
level 86 g/L (8.6 g/dL); hematocrit 0.25 L/L (25%); MCV 132 fL;
MCHC 34.4 g/dL; plate-let count 100 * 109/L 1100,000/¼ L 2. Cabot B. Pernicious anemia
rings are noted on the peripheral smear.
The clinical and laboratory findings are most consistent with
A. Liver disease
B. Pernicious anemia
C. Folic acid deficiency
D. Aplastic anemia
276. Which of the following is not associated with this disorder?
A. Alcoholism
B. Antibodies to intrinsic factor or parietal cells C. Diphyllobothrium A. Alcoholism
latum infection
D. Achlorhydria
277. Which of the following statements about megaloblastic ane-
mia is true?
A. Oral folate therapy reverses the neuro-logic symptoms of PA.
B. Intramuscular injections of vitamin B12 will reverse the neuro- B. Intramuscular injections of vitamin B12 will reverse the neuro-
logic symptoms of PA. logic symptoms of PA.
C. Methotrexate (chemotherapeutic agent) is a vitamin B12 an-
tagonist.
D. Folate deficiency takes years to develop.
(278-280) A 32-year-old African-American travel-ing to Africa on
business had been healthy until he began taking primaquine for
pre-vention of malaria. He went to his physi-cian because he felt
faint and his urine was black. His CBC results are as follows:
WBC 6.5 * 109/L 16.5 * 1 0 3 /¼L 2 ; RBC 1.67 * 1012/L 11.67 *
31 / 35
1 0 6 /¼
L 2 ; hemoglo-bin level 50 g/L (5.0 g/dL); hematocrit 0.15 L/L
(15%); MCV 89.8 fL; MCHC 33.3 g/dL; platelet count 175 * 109/L
1175,000/¼ L 2; reticulocyte 25.0%
The most likely cause of this hemolytic episode is
A. G6PD deficiency
A. G6PD deficiency
B. Hereditary spherocytosis
C. Sickle cell disease
D. Pyruvate kinase deficiency
279. The defect in this disorder is caused by an
A. Amino acid substitution
B. Intrinsic red blood cell membrane defect C. Enzyme deficiency in the hexose mono-phosphate shunt
C. Enzyme deficiency in the hexose mono-phosphate shunt
D. Enzyme deficiency in the Embden-Meyerhof pathway
280. Inclusions that form when the patient is oxidatively chal-
lenged are composed of
A. RNA
B. Denatured hemoglobin
B. Denatured hemoglobin
C. DNA
D. Iron
(281-283) A 15-month-old malnourished child is brought to the
clinic for a routine ex-amination. Her CBC results are as follows:
WBC 9.5 * 109/L 19.5 * 103/¼L 2; RBC 2.70 * 1012/L 12.70 * 106/¼
L 2;
hemoglobin 67 g/L (6.7 g/dL); hematocrit 0.25 L/L (25%); MCV
73.5 fL; MCHC 26.8 g/dL; reticulocyte 0.2%; RDW 19%. Abnormal
RBC morphol-ogy present included pencil forms and target cells. C. Iron deficiency
What is this toddler's most probable diag-nosis?
A. Folic acid deficiency
B. Hereditary spherocytosis
C. Iron deficiency
D. Erythroblastosis fetalis
282. The earliest indicator of this disease state is
A. Decreased folic acid
B. Decreased serum iron C. Decreased serum ferritin
C. Decreased serum ferritin
D. Increased bilirubin
283. What is the toddler's absolute reticulocyte count?
A. 0.05 * 109/L
B. 0.5 * 109/L C. 5 * 109/L
C. 5 * 109/L
D. 50 * 109/L
(284-288) An 8-year-old girl is seen by the fam-ily physician.
On physical examination, the physician notes fever, sore throat,
bruising, petechiae, and pallor. A CBC is drawn and the results are
as follows: WBC 110 * 109/L 1110 * 1 0 3 / ¼L 2 ; RBC 1.70 * 1012/L
11.70 * 106/¼ L 2; hemoglobin 55 g/L (5.5 g/dL); hematocrit 0.16 L/L
(16%); differential count shows 93% blasts and 7% lymphocytes.
A bone marrow examination is performed and reveals 85% blasts.
A. 10 * 109/L
All of the blasts are small with no variation in their appearance.
Which of the following would you expect to most accurately reflect
the child's platelet count?
A. 10 * 109/L
B. 100 * 109/L
C. 200 * 109/L
D. 400 * 109/L
285. What is this child's most probable diagnosis?
A. Acute lymphoblastic leukemia
B. Acute myelogenous leukemia A. Acute lymphoblastic leukemia
C. Hairy cell leukemia
D. Myelodysplastic syndrome

32 / 35
286. Which of the following cytochemical stains would most likely
be positive in the blast cells of this patient?
A. Myeloperoxidase
C. Periodic acid-Schiff
B. Leukocyte alkaline phosphatase
C. Periodic acid-Schiff
D. Nonspecific esteras
287. Terminal deoxyribonucleotidyl transferase (TdT) is present in
A. Precursor B and precursor T lymphoid cells
B. Mature B and T lymphocytes A. Precursor B and precursor T lymphoid cells
C. Precursor B cells and precursor T my-eloid cells
D. Precursor T cells and mature T lympho-cytes
288. The presence of CD2, CD5, CD7 and the absence of CD10
(CALLA) are associated with A. B lymphocytes
B. T lymphocytes B. T lymphocytes
C. Myeloid cells
D. Monocytic cells
(289-292) The peripheral blood smear in Color Plate 17 and the
Sudan black B stain in Color Plate 19 are from a 90-year-old man
com-plaining of fatigue and nosebleeds. The physician noted the
patient was febrile and had petechiae. CBC results were as fol-
lows: WBC 20.0 * 109/L 120.0 * 1 03/¼ L 2; RBC 2.58 * 1012/L 12.58
* 106/¼ L 2; hemoglobin 77 g/L (7.7 g/dL); hematocrit 0.24 L/L (24%);
platelet count 32 * 109/L 132,000/¼ L 2; dif-ferential count shows
75% blasts, 20% lym-phocytes, and 5% segmented neutrophils.
A bone marrow examination revealed 80% cellularity with 80% B. Acute myelogenous leukemia with maturation (FAB type M2)
blasts. The blasts were myeloperoxidase and specific esterase
posi-tive; nonspecific esterase and PAS negative.
What is this patient's most likely diagnosis?
A. Acute myelogenous leukemia without maturation (FAB type
M1)
B. Acute myelogenous leukemia with maturation (FAB type M2)
C. Acute monocytic leukemia (FAB type M5)
D. Myelodysplastic syndrome
290. Cytogenetic studies would most likely show which of the
following chromosome abnormalities?
A. t(8;21)
B. t(8;14) A. t(8;21)
C. t(9;22)
D. t(15;17)
291. Using FAB classification (FAB) criteria for the diagnosis of
acute leukemia, the per-centage of bone marrow blasts must be
at least
A. 5 C. 30
B. 20
C. 30
D. 50
292. Which of the following is not considered an underlying con-
dition that predisposes a patient to acute leukemia?
A. Viral infections
B. Bacterial infections B. Bacterial infections
C. Chronic bone marrow dysfunction
D. Congenital chromosome abnormalities
(293-296) An 83-year-old woman is seen in the emergency de-
partment complain-ing of fatigue and recent weight loss. Her CBC
results are as follows: WBC 2.6 * 109/L 12.6 * 103/¼ L 2; RBC 2.79 *
1012/L 12.79 * 106/ ¼ L 2; hemoglobin 92 g/L (9.2 g/dL); hematocrit
0.28 L/L (28%); MCV 100.0 fL; RDW 23.5%; platelet count 42 *
109/L 142,000/¼ L 2; differential count shows 42% segmented neu-
trophils, 45% band neutrophils, 3% lymphocytes, 3% metamyelo-
cytes, 4% myelocytes, 3% blasts, and 4 nRBC/100 WBC. Morpho-
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logic chang-es noted on the differential smear include poor gran-
ulation and hyposegmentation of the neutrophils, giant platelets
that display poor granulation, oval macrocytes, baso-philic stip-
pling, Cabot rings, Pappenheimer bodies, and Howell-Jolly bod-
ies. Three mi-cromegakaryocytes are seen per 100 WBCs. Serum
B12 and folate levels are normal. A. Myelodysplastic syndrome
The peripheral blood findings are most consistent with
A. Myelodysplastic syndrome
B. Degenerative left shift
C. Megaloblastic anemia
D. Chronic myelogenous leukemia
294. The expected bone marrow findings in this disorder using
WHO criteria are
A. Hypocellular; blasts Ú 20,
D. Hypercellular; blast <20%
B. Hypocellular; blasts 620,
C. Hypercellular; blasts Ú 20,
D. Hypercellular; blast <20%
295. If the bone marrow in this patient had 18% blasts, the most
likely disorder would be
A. Chronic myelomonocytic leukemia (CMML) B. Chronic myel-
D. Refractory anemia with excess blasts (RAEB)
ogenous leukemia (CML)
C. Refractory anemia with ringed sidero-blasts (RARS)
D. Refractory anemia with excess blasts (RAEB)
296. Which of the following is a false statement about myelodys-
plastic syndromes?
A. MDS is "preleukemic" and frequently terminates in acute
leukemia. C. Median survival for all types of MDS is 5 years.
B. Treatment for MDS is only supportive and not a cure.
C. Median survival for all types of MDS is 5 years.
D. The lower the blast percent, the longer is the survival rate
(297-300) A 53-year-old man reported to the labora-tory for rou-
tine blood work as part of a yearly physical. He had been feel-
ing tired for the last few months. Physical examination re-vealed
splenomegaly. His CBC results are as follows: WBC 80.0 * 109/L
180.0 * 103/ ¼ L 2; RBC 4.10 * 1012/L 14.10 * 1 06/¼ L 2; hemoglobin
123 g/L (12.3 g/dL); hema-tocrit 0.37 L/L (37.0%); platelet count
650 * 109/L 1650,000/¼ L 2; differential count shows 40% poly-
morphonuclear neutrophils, 18% bands, 5% metamyelocytes, 7%
B. Chronic myelogenous leukemia
myelo-cyte, 28% lymphocytes, and 2% monocytes. No RBC or
WBC morphologic abnormalities are seen
The peripheral blood findings are most con-sistent with a diagno-
sis of
A. Neutrophilic leukemoid reaction
B. Chronic myelogenous leukemia
C. Acute myelogenous leukemia
D. Regenerative left shift
298. Which of the following would yield the most diagnostic infor-
mation for this patient?
A. Sudan black B (SBB)
B. Periodic acid-Schiff (PAS) D. Leukocyte alkaline phosphatase (LAP)
C. Tartrate-resistant acid phosphatase (TRAP)
D. Leukocyte alkaline phosphatase (LAP)
299. Which of the following myeloproliferative disorders is charac-
terized by the presence of a t(9;22) chromosome abnormality and
the BCR/ABL oncogene?
A. Polycythemia vera C. Chronic myelogenous leukemia
B. Acute myelogenous leukemia
C. Chronic myelogenous leukemia
D. Chronic idiopathic myelofibrosi

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300. How does the presence of this chromosome abnormality
affect the prognosis?
A. It is not a prognostic indicator.
B. The prognosis is worse when the abnor-mality is present. C. The prognosis is better when the abnor-mality is present.
C. The prognosis is better when the abnor-mality is present.
D. Progression to acute lymphoblastic leuke-mia occurs more
often when the abnor-mality is present

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